Relation between achieved heart rate and outcomes in patients with atrial fibrillation (from the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] Study)

Cooper, Howard A.; Bloomfield, Dennis A.; Bush, David E.; Katcher, Michael S.; Rawlins, Michele; Sacco, Joseph; Chandler, Mary L.

doi:10.1016/j.amjcard.2004.01.069

Cited by 103 publications

(61 citation statements)

References 14 publications

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“…Estimates of treatment allocation for people with AF were taken from two studies, with costs for antithrombotics taken from a cross-sectional community study carried out in 1998 76 and costs for digoxin, beta-blockers and calcium channel blockers based on the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. [77][78][79] In addition, people with chronic AF were assumed to make eight visits per year to their general practitioner (GP). Those on warfarin were assumed to require a further two specialist outpatient visits and a further eight anticoagulation clinic visits.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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BackgroundBradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of the heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance and fainting. The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker.ObjectiveTo appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block.Data sourcesAll databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched from inception to June 2014.MethodsA systematic review of the clinical and economic literature was carried out in accordance with the general principles published by the Centre for Reviews and Dissemination. Randomised controlled trials (RCTs) evaluating dual-chamber and single-chamber atrial pacemakers and economic evaluations were included. Pairwise meta-analysis was carried out. A de novo economic model was developed.ResultsOf 493 references, six RCTs were included in the review. The results were predominantly influenced by the largest trial DANPACE. Dual-chamber pacing was associated with a statistically significant reduction in reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 to 0.63] compared with single-chamber atrial pacing. The difference is primarily because of the development of AV block requiring upgrade to a dual-chamber device. The risk of paroxysmal atrial fibrillation was also reduced with dual-chamber pacing compared with single-chamber atrial pacing (OR 0.75, 95% CI 0.59 to 0.96). No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation or quality of life. However, the risk of developing heart failure may vary with age and device. The de novo economic model shows that dual-chamber pacemakers are more expensive and more effective than single-chamber atrial devices, resulting in a base-case incremental cost-effectiveness ratio (ICER) of £6506. The ICER remains below £20,000 in probabilistic sensitivity analysis, structural sensitivity analysis and most scenario analyses and one-way sensitivity analyses. The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers. Results from an analysis based on age (> 75 years or ≤ 75 years) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers (i.e. are less expensive and more effective) in older patients, whereas dual-chamber pacemakers are dominated by (i.e. more expensive and less effective) single-chamber atrial pacemakers in younger patients. However, these results are based on a subgroup analysis and should be treated with caution.ConclusionsIn patients with SSS without evidence of impaired AV conduction, dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers. The risk of developing a complete AV block and the lack of tools to identify patients at high risk of developing the condition argue for the implantation of a dual-chamber pacemaker programmed to minimise unnecessary ventricular pacing. However, considerations have to be made around the risk of developing heart failure, which may depend on age and device.Study registrationThis study is registered as PROSPERO CRD42013006708.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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“…In fact, a substudy of AFFIRM trial showed that after controlling for covariates, there were no significant relation between either achieved heart rate at rest or achieved exercise heart rate and event-free survival. 12 However, in the present survey there was a clear relationship between cardiovascular risk factors control and higher heart rate; higher heart rate, worse control. It is likely that this lower control found in patients with AF and higher heart rate may increase the risk of adverse events.…”

Section: Discussionmentioning

confidence: 39%

“…[8][9][10] However, in patients with AF, the relationship between heart rates and adverse outcomes is less established. 11,12 CINHTIA (Cardiopatía Isquémica cróNica e HiperTensIón Arterial en la práctica clínica en España) was a cross-sectional and multicenter survey aimed to define the clinical profile of hypertensive patients with chronic ischemic heart disease attended in daily practice across Spain. In this manuscript, the profile and clinical management of the patients with AF is examined.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation and coronary heart disease: fatal attraction

Barrios¹,

Escobar²,

Echarri³

2009

J.A.F.I.B

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Atrial fibrillation (AF) is the most common arrhythmia found in clinical practice. It has been estimated that about 2.3 million people in North America and 4.5 million people in the European Union have paroxysmal or persistent AF.1 Moreover, this condition will likely increase in the following years due to the ageing of the population and a rising prevalence of chronic heart disease.2 AF doubles the mortality rate in affected patients and this condition is associated with a greater risk of stroke and heart failure. 3,4 Some years ago, the AFFIRM trial reported that the management of AF with the rhythm-control strategy offered no survival advantage over the rate-control strategy, and that there were potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. This study also emphasized the need of anticoagulation regardless the strategy used in high-risk pa- AbstractIn this manuscript, the profile and clinical management of hypertensive patients with chronic ischemic heart disease and atrial fibrillation (AF) is examined and whether high heart rate is associated with a different profile is determined. CINHTIA was a cross-sectional and multicenter survey aimed to define the clinical profile of hypertensive patients with chronic ischemic heart disease daily attended in Spain. The group of patients with AF was older and with higher prevalence of diabetes, organ damage and cardiovascular disease. Blood pressure (41.8% vs 34.5%, p=0.014) and diabetes (28.5% vs 20.9%,p=0.044) were worse controlled in patients with AF, with a trend to a lower control of LDL-cholesterol (31.2% vs 26.8%, p=0.093). When distributing patients with AF according to heart rate, except for smoking, left ventricular hypertrophy and peripheral arterial disease that were more frequent in those with higher heart rate, no significant differences were found in other risk factors or organ damage between groups. Blood pressure, glycemia and LDL-cholesterol were worse controlled in the subgroup with highest heart rate. In clinical practice, hypertensive patients with chronic ischemic heart disease and AF have a bad prognosis not only due to a worse clinical profile, but also due to lower risk factors control rates. In contrast with patients at sinus rhythm, higher heart rate was less related with a worse clinical profile in subjects with AF.

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“…Данные о влиянии антиаритмических и хроно-тропных средств на качество жизни не однозначны [116,130,131]. В исследованиях AFFIRM [132], RACE [124], PIAF [125] и STAF [126] не было выявлено раз-ницы качества жизни на фоне контроля ЧСС или рит-ма. Контроль ритма в исследованиях PIAF и HOT CAFE [127] обеспечивал улучшение толерантности к физи-ческой нагрузке по сравнению с таковой на фоне кон-троля ЧСС, однако это не привело к улучшению каче-ства жизни.…”

Section: контроль частоты сердечных сокращений или ритмаunclassified

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Ryden²,

Cannom³

et al. 2007

Racionalʹnaâ farmakoterapiâ v kardiologii

120

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Отчет рабочей группы Американской коллегии кардиологов и Американской ассоциации сердца по практическим рекомендациям и комитета Европейского общества кардиологов по практическим рекомендациям Рекомендации разработаны в сотрудничестве с Европейской ассоциацией сердечного ритма и Обществом сердечного ритма Авторы (члены рабочей группы): V.

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Relation between achieved heart rate and outcomes in patients with atrial fibrillation (from the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] Study)

Cited by 103 publications

References 14 publications

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Atrial fibrillation and coronary heart disease: fatal attraction

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

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